Initial drug resistance among tuberculosis patients under DOTS programme in Banglore city
Vijay, Sophia; Balasangameshwara, V.H.; Jagannatha, P.S. and Kumar, P. (2004) Initial drug resistance among tuberculosis patients under DOTS programme in Banglore city. Indian Journal of Tuberculosis, 51. pp. 17-21.
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Background & Objectives: The level of initial drug resistance (IDR) and its trend is a sensitive indicator of the programme efficiency and provides indirect reflection of the quality of tuberculosis services in the area. Studies from some parts of India have reported an increase in the level of IDR to INH and Rifampicin. There is paucity of information on age specific pattern of IDR from India. Frequency of drug resistance in the younger age group provides a precise evaluation of the current situation. The published data from Bangalore (1985-86) pertaining to patients under the National TB programme reported an IDR of 20.6% to any drug. Subsequently, the RNTCP with DOTS strategy to achieve high cure rate was implemented in the area in late 1998. The present study was undertaken in a cohort of 324 new smear positive patients initiated on Cat-I regimen under RNTCP in Bangalore Mahanagara Palike from April to December 1999 to study the pattern of IDR among them, soon after RNTCP implementation in the area. This information would serve as a useful baseline data for the area to assess the impact of DOTS strategy on the levels of IDR subsequently. Material & Methods: Two pre-treatment sputum samples were collected from these patients and subjected to microscopy, culture & susceptibility testing at the National Tuberculosis Institute. The susceptibility testing was done by economic vesion of proportion method, as per IUATLD guidelines. Information regarding the previous treatment was elicited using a pre-tested semi-structured schedule based on the WHO questionnaire for IDR surveillance and scrutiny of available records. Results: Among the 271 correctly categorized new patients, 27.7% were resistant to one or more drugs. The resistance to streptomycin was highest (22.5%) followed by INH (13.7%), and MDR was 2.2%. The age specific resistance was highest in <25 years and declined significantly in the higher age groups, being lowest (17.7%) in >45 years. Effective RNTCP implementation is expected to show declining trends in the IDR, particularly in the younger age group during the subsequent surveys.
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